Predicting response to treatment for anxiety and depression

Our brain cells communicate with each other through chemical messengers. Medication and talk therapy, among other things, can alter this process.

Prescribing the right medication or therapy for anxiety and depression often consists of a trial and error approach. It is very difficult to tell who is going to respond to a specific treatment because there is no single cause, so no simple remedy or cure. A multitude of factors can play a role. Whether it’s altering the way our brain cells communicate with medication or talk therapy, anxiety and depression are complicated conditions with no easy fix.

An extensive amount of research is being conducted to improve the odds that any given treatment will be effective. A recent Bloomberg Newsarticle discusses the progress being made in depression treatment prediction. In his article, Ryan Flinn writes:

“About 15.5 million people reported struggling with bouts of depression in a 2010 U.S. survey, and 11 percent of Americans 12 and older are treated for the disorder, according to the Centers for Disease Control and Prevention. Depression costs U.S. employers more than $34 billion a year in lost productivity and, in the worst cases, often leads to suicide, according to the National Alliance on Mental Illness, an Arlington, Virginia patient advocacy group.”

Often patients may try three or four different anti-depressant medications before finding the one that works. But now, companies are offering treatment outcome prediction tests ranging from brain scans, to genetic tests, to cognitive assessments. What may prove to be the most accurate is a combination of tests.

Let’s talk specifics. Electrical activity in the brain can be recorded, and if a patient’s “brain waves” match up with the brain waves of subjects who responded well to a specific treatment option, that same treatment is more likely to be effective.

Genetic tests can also give us some insight into what treatment options may be the most effective. From genetic information obtained from a blood test or cheek swab, researchers can determine how efficiently different medications are broken down or metabolized.

Cognitive tests that evaluate thinking, feeling, self-regulation and emotion are also a good measure of who will respond best to what type of depression medication or therapy. Studies are now underway to determine the “cognitive markers” that predict optimal response to various forms of treatment.

A new study by scientists at MIT and their colleagues has demonstrated that functional Magnetic Resonance Imaging (fMRI) of subjects with a specific type of anxiety called social anxiety disorder can help predict response to cognitive behavioral therapy.

By looking at images of faces before and after therapy, scientists were able to determine that those subjects who had the greatest difference in brain activity in the visual cortex when looking at angry versus neutral faces, showed the most improvement after 12 weeks of cognitive behavioral therapy. Their findings were published in the Archives of General Psychiatry.

“Our vision is that some of these measures might direct individuals to treatments that are more likely to work for them,” says John Gabrieli, a professor of Brain and Cognitive Sciences at MIT, in a news release from the university.

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